- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $75.22 / $75.22 / $127.85
| Facility | 26 | $75.22 | $75.22 | $127.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $151.36 / $153.99
| Professional | | $130.66 | $151.36 | $153.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $312.20 / $368.87
| Professional | | $289.52 | $312.20 | $368.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.01 / $254.41 / $395.53
| Professional | | $162.01 | $254.41 | $395.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.66 / $286.64 / $920.53
| Professional | | $152.66 | $286.64 | $920.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.66 / $266.89 / $379.97
| Professional | | $152.66 | $266.89 | $379.97 |